We are not aware of statistics in the LGBT community in India on drug usage. In the gay community users seem to be a minority, but within that minority, usage appears to be significant. It has been difficult to find resource persons for holding this workshop though Gay Bombay has wanted to for many years. This is because their philosophies tend to be moralistic and while not condoning usage, we wanted a non-judgmental approach. The aim of this workshop is to develop awareness of risks in order to foster assumption of responsibility by LGBTIQ community members.

1) Rise of Chemsex on London’s Gay Scene: In the video, users in the London gay community grappled with deep rooted problems of avoidance, intimacy, hiding self, and hyper-vigilance. Smartphone apps have normalized drug use, with no frame of reference. No causal link between chemical sex and HIV but incidences were on the rise. Study of PREP (pre exposure prophylaxis) use saw reduction in HIV.

2) Addiction and the Rat Park experiments: Persons access to functioning social life as important as reducing availability and penalizing usage. Lack of confidence and experiencing loneliness can make it difficult to quit.

Exercise

Participants were asked to write their life aspirations on one side of a sheet of paper and substances they knew on the other, with a tick mark for the substance they came into contact with. Differences between ‘drug’ and ‘substance’, ‘dependence’ and ‘addiction’, ‘substance’ and ‘behavior’ dependency were clarified.

Stories

“I think it is a problem in our community. My friend started doing crystal meth, few months later he tested positive for HIV, mainly due to lack of judgment and taking more risks.”

“Sex lives viewed as intrinsically connected to drug usage.”

“Using stopped him from caring and protecting himself. Got into a 12-step recovery program, he feels alive again.”

“A gay friend couldn’t go out and speak what he was feeling. He lost job, got into prostitution. Then he had a grand wedding with a woman who didn’t know he was gay. He was taken to mental hospital 3 months later. Now he is completely incommunicado. As friends we tried reaching out at every stage, but didn’t succeed.”

“His father was alcoholic, and partner of 3 years uses drugs. People want to blame everything on drugs, for not doing things right, for failure. They do take vodka shots as dancers before going on stage. A friend has lost partner due to overdose on drugs, but he has also seen moments of pleasure. They take it as artists when they don’t want to feel nervous or judged.”

Aspects

(1) Defining addiction or dependence

“Addiction is a behavior that gets in the way of normal day to day duties and life, doesn’t let you achieve your goals in a persistent way. There is a correlation between factors like loneliness etc, but not necessarily causation.”

The role of neurotransmitters, high and low effect of drugs (highs included feeling loved, acceptance, absence of stress), secondary effects (like weight loss), and difference between physiological (body effects like tremors) and psychological addiction (rationalization with ‘but I only have…’), excitatory and inhibition lowering drugs were discussed.

(2) How it begins

“Friends who are not into drugs, met persons through dating site, and try it on their behest. How to be careful about not getting into it?”

“Curiosity, peer pressure, low self-image, thrill, boredom, ignorance, propensity to try everything once, the need for pleasure, the need to appear cool, narration of a user’s positive experience, cause people to begin. There are few healthy spaces for gay men to meet like picnics or socials. Meeting is largely on hookup sites or parties, where you don’t want to talk about anything, just enjoy. Clusters of guys are formed which are very tight, and these may drive behavior of drug use.”

“Nobody reads the “conditions applied” fine print in life. Blame it on the modern world, but we want something more all the time.”

“I have many friends addicted to methadone, with the idea that it gives you glorious sex, though it is not true, as it kills the erection but makes it horny. Before shooting up, they take Viagra and shoot up, so two substances are taken. And it works. Sex is a sure-shot biological way of feeling accepted, desired and wanted, to be let inside their body, a biological evidence of acceptance.”

“Use not only associated with sex, but there is also the party, socializing drug. People do it for these reasons too. Can you be a healthy user, become an abuser, or get out?”

“It is tough to be disciplined all the time, get to work on time everyday, so these parties become our way to unwind. It’s also a way to process past hurts, like a breakup. When you are emotionally low, you are vulnerable and likely to.”

“Drugs replace some kind of a void, like not being successful at work. It may have nothing to do with sex.”

“A friend who does a lot of weed says it is a natural product so it is good for digestion. Is it really good? Medical marijuana was offered to my mom to reduce pain. A form of heroine, morphine given in a way people can manage, dosage on advice of doctor. Frequency, duration and intensity has to be decided by prescriber.”

For Aspects (1) and (2) please see the website provided in the Resource List above: “The Science of Addiction”

(3) Problems from usage

Financial both in terms of cost, as well as lost earnings in future.

Health: physical and mental aspect.

Socio-cultural

Interpersonal

Productivity

“In India, a big problem with all illegal substances is there is no quality control and adulteration, side effects. Bad stuff may cause higher intake, without knowing the adulterant.”

“One very common substance right now is Meow-Meow: There is a strong desire to re-dose, craving to recapture initial rush, to increase dose to overcome tolerance, uncontrollable changes in body temperature, dehydration due to not drinking water, impaired short term memory, insomnia, teeth grinding, etc”

“If you have sex with a drug user, does it heighten your risk of infections?”

-“ In case of unprotected sex, yes, but consumed drug is likely not transmitted through body fluids. Please look at resources indicated for accurate information.”

“I feel that drugs help with the creative process when taken correctly. I have a friend who does marijuana every night, but is very spiritually evolved, and talking to him makes me feel better. Sensitivity is different in people, and hence effects vary based on internal make-up.”

“There is a spectrum of education available on different substances. For alcohol, the message nowadays is enjoy responsibly. After a few years, that may be so for certain drugs too. There is not enough support for drug usage, forget about for LGBT.”

“MDMA is the main focus, as that is happening a lot in the community. Risks spiral out of control. People who can’t afford, start injecting (slamming) rather than oral. Then issues with needles begin, most don’t know how to inject, no equipment, not sterilized, bacterial contamination, leading to blood to blood contact for sero-conversion.”

“Initially everyone conscious of individual needles, but in a users party, as progressive control of reality is lost, needles start getting shared.”

(4) Usage Persistence

“Human propensity for short-term pleasure, the attraction of forbidden fruit.”

“A person started seeing someone and quit friends, and when broke up, was all alone. Hence took solace in drugs. When you want to leave it and are not able to you must ask for help.

“A doctor didn’t know what weed is, can we have access to doctors who know more about drugs?”

“Drug use and failure can become a self-fulfilling prophecy. Low frustration tolerance is one of the major reasons to continue any addiction.”

For Aspects (3) and (4) please see the websites provided in the Resource List above: “Commonly Abused Drugs and Prescription Medicines” and “Medical Consequences of Drug Abuse”.

(5) How to help

“I have a friend who badly needs help, but if I tell him, he reacts badly. How can I help as he can afford it. Do we have support system within the city?”

“If someone is not willing to get help, when they are in good mood, keep encouraging them by giving them resources and support contacts. Talk to a counselor in earlier stages to figure out the need to get help. Psychotherapist can work on deep seated issues. Clinical psychologist can give you intervention based on which drug you use.”

“In case of an overdose, rush to emergency department of any Grade 1 hospital for anti-toxic treatment.”

“Harm reduction techniques include the ‘gatekeeper policy’, or having a trusted person at hand to make sure one doesn’t do anything harmful to self or others, addressing loneliness and leaving an authentic and social life.”

For Aspect (5) please see the website provided in the Resource List above: “Providers Guide to Treatment for LGBT individuals”